Three steps play a key role when assessing patients with suspected endometriosis.
First step: Patient’s clinical history and symptoms (dysmenorrhea, dyspareunia, dyschesia and chronic pelvic pain). Although there is no evidence of a relationship between patient’s symptoms and the presence and severity of endometriotic lesions, the implemented or proposed medical / surgical treatment depends on the context in which endometriosis is observed.
The second step is the physical examination, including evaluation of the posterior vaginal fornix and of the Douglas pouch, which detects more lesions that are missed on ultrasonography and magnetic resonance imaging.
The third step is imaging. A recent meta-analysis found no difference in the detection of endometriotic lesions between ultrasound and magnetic resonance imaging, but these examinations should be performed by a radiologist with expertise in this field.
To date, the final diagnosis of endometriosis is made by laparoscopy with biopsies of the lesions.
Endometriosis, pelvic pain, dysmenorrhea
What is already known about the topic?
The endometrium affects 5 to 10% of women between menarche and menopause. Any permenstrual cyclic symptomatology should evoke a potential diagnosis of endometriosis. No symptoms are unfortunately specific to endometriosis. Patient management should be based on an anamnesis and continuous communication adapted to the evolution of clinical examination and imaging. Multidisciplinary management should be considered given the frequent recurrence of symptoms
What does this article bring up for us?
Knowledge about endometriosis is limited by not having an available animal model and the difficulties of proving the presence of the model without an invasive surgical procedure. The delayed diagnosis of the pathology can explain the lack of confidence of the patients towards the therapists. Frequent recurrences of symptomatology and pathology require regular monitoring